Can time heal all wounds? An empirical assessment of adaptation to functional limitations in an older population

Adaptation and illness severity: the significance of suffering

Adaptation to illness, and its relevance for distribution in health care, has been the subject of vigorous debate. In this paper I examine an aspect of this discussion that seems so far to have been overlooked: that some illnesses are difficult, or even impossible, to adapt to. This matters because adaptation reduces suffering. Illness severity is a priority setting criterion in several countries. When considering severity, we are interested in the extent to which an illness makes a person worse-off. I argue that no plausible theory of well-being can disregard suffering when determining to what extent someone is worse-off in terms of health. We should accept, all else equal, that adapting to an illness makes the illness less severe by reducing suffering. Accepting a pluralist theory of well-being allows us to accept my argument, while still making room for the possibility that adaptation is sometimes, all things considered, bad. Finally, I argue that we should conceptualize adaptability as a feature of illness, and thereby account for adaptation on a group level for the purposes of priority setting.

Does becoming an informal caregiver make your health worse? A longitudinal analysis across Europe

OBJECTIVE

To determine whether becoming an informal caregiver in Europe has a significant effect on health status, compared with non-informal caregivers, distinguishing by place of residence (in or outside the home of the care receivers) and country. And to determine whether there is an adaptation effect after the passage of time.

METHODS

The Survey of Health, Aging and Retirement in Europe (2004-2017) was used. Propensity score matching was applied to analyse the differences in the health status of people who became informal carers between different periods and those who did not. We considered short-term (2-3 years after the shock) and medium-term effects (4-5 years).

RESULTS

In the short term, the probability of those who became informal caregivers being depressed was 3.7% points (p.p.) higher than among their counterparts, being higher among those who lived in the care recipients' homes (12.8 p.p.) and those providing care outside and at home (12.9 p.p.). Significant differences in the probability of being depressed were also observed by country (Southern and Eastern Europe), and in countries with low expenditure on long-term care (LTC). Those effects remained in the medium term. No significant effects were found in cancer, stroke, heart attack and diabetes.

CONCLUSIONS

The results might help to concentrate a major effort of any policy in the field of mental health on the period immediately after the negative shock, especially for those caregivers who live with the care receiver, for those in Southern and Eastern Europe and in countries with low expenditure on LTC.

Adaptation in life satisfaction and self-assessed health to disability - Evidence from the UK

Experiencing deteriorating health has implications for your quality of life. The theory of adaptation suggests that with time spend living in a health state individuals can adapt, resulting in observed quality of life levels to revert or stagnate despite persistently decreased health. Adaptation has implications for the use of subjective quality of life indicators when quantifying the impact of health changes or the benefits from new medical technologies. As both the impact from ill health and the benefit from new interventions might be disease- or subgroup-specific adaptation further raises ethical concerns but empirical evidence on its existence, magnitude, and heterogeneity remains inconclusive. This paper uses a general population sample of 9,543 individuals that participate in the UK Understanding Society survey and experience the onset of a long-standing illness or disability to provide evidence on these questions. Using ordered-response fixed effects models we explore longitudinal changes in self-assessed health and life satisfaction around the onset of disability. Our results indicate that disability onset is associated with large decreases in subjective health and well-being. Over time this initial decrease in subjective quality of life indicators attenuates, especially in life satisfaction and to a lesser extent for self-assessed health. While the relative difference in adaptation across these two measures remains persistent, we find that across demographic and severity groups the initial impact of disability onset and adaptation differs considerably in its magnitude. These results have important implications for studies aiming to quantify the impact of health conditions on quality of life outcomes, especially when using observational datasets.

Long-Term Effects on Loneliness of a Computer-Tailored Intervention for Older Adults With Chronic Diseases: A Randomized Controlled Trial

Objectives: This study explores the effects of the Active Plus intervention aiming to decrease loneliness among older adults (>65 years) with chronic diseases. Methods: A randomized controlled trial (RCT) was performed (N = 585; age: M = 74.5 years, SD = 6.4), assessing loneliness at baseline, 6 months and 12 months. Outcome measures in the multilevel linear regression analyses were total, social and emotional loneliness. Results: At 12 months, significant decreases in total (B = -.37, p = .01) and social loneliness (B = -.24, p = .02) were found. Age was a significant moderator for total and social loneliness; however, the intervention was effective only for participants aged 80 years and older. Discussion: The Active Plus intervention showed a significant decrease in total and social loneliness and was especially beneficial for the vulnerable age group of 80 years and older. A more comprehensive tool for measuring social activity and mobility impairments, and using a longer time frame to detect loneliness changes, may form interesting future research.

Longitudinal validity of self-rated health: the presence and impact of response shift

Objective: This paper aimed to examine the longitudinal validity of self-rated health (SRH) and whether it would be affected by possible changes in evaluation standards (i.e., response shift) over time.Design: Data are from a longitudinal survey of a nationally representative sample in China. Analytical sample was restricted to respondents aged 45 and above (n = 15,893). Individual fixed effects models were used to analyze changes in ratings on health anchoring vignettes and self-rated health over time.Main outcome measures: SRH at two time points with a -two-year span.Results: Both SRH and anchoring vignettes ratings displayed changes over a two-year span for all the studied age groups. Compared with the self-assessed change in health ("How would you rate your health as compared to that of last year?"), changes in SRH reported over time displayed a more stable and optimistic pattern. SRH responded to doctor diagnosed chronic disease and changes in functional limitation, before and after adjusting for evaluation standards.Conclusion: SRH is responsive to the newly diagnosed chronic disease and functional limitation, regardless of whether we consider response shift within the same respondents over time.

Does ageing alter the contribution of health to subjective well-being?

Older adults regularly report rising levels of Subjective Well-Being (SWB) over time, despite a concomitant decline in their health. One possible explanation is that individuals develop psychological mechanisms to diminish the contribution of health to their well-being as they get older. This research examines whether observational data are consistent with this hypothesis of hedonic adaptation to health decline with ageing, in all aspects of SWB, and for different births cohorts over time. Using longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE) between 2007 and 2015 in 10 European countries for respondents aged 50 onwards (4 waves, 41,258 individuals), we estimated panel fixed-effects models for outcomes measuring the three aspects of SWB: evaluative (life satisfaction), experienced (positive and negative affectivity) and eudemonic well-being (sense of purpose and meaning in life). We decomposed age in birth cohort and time fixed effects. Changes over time in the contribution of health to SWB were estimated by interaction terms between health and time fixed effects. Results showed that the value of health changes over time and for different birth cohorts in ways that depend on the measure of SWB. Ageing increases the importance of health for both eudemonic and experienced well-being. By contrast, the association between health and life satisfaction weakens with age, except for individuals aged 80 and above for which it strengthens. Our results thus offer only little support for hedonic adaptation to health decline with age, restricted to life satisfaction and individuals under 80 years of age. These findings caution against the use of mean estimations over the lifespan to determine the value of health as well as against the use of the various forms of SWB interchangeably in public policy analysis and economic evaluations of healthcare.

Happy with Your Capabilities? Valuing ICECAP-O and ICECAP-A States Based on Experienced Utility Using Subjective Well-Being Data

Background. The ICECAP-O and the ICECAP-A are validated capability well-being instruments. To be used in economic evaluations, multidimensional instruments require weighting of the distinguished well-being states. These weights are usually obtained through ex ante preference elicitation (i.e., decision utility) but could also be based on experienced utility. Objective. This article describes the development of value sets for ICECAP-O and ICECAP-A based on experienced utility and compares them with current decision utility weights. Methods. Data from 2 cross-sectional samples corresponding to the target groups of ICECAP-O and ICECAP-A were used in 2 separate analyses. The utility impacts of ICECAP-O and ICECAP-A levels were assessed through regression models using a composite measure of subjective well-being as a proxy for experienced utility. The observed utility impacts were rescaled to match the 0 to 1 range of the existing value set. Results. The calculated experienced utility values were similar to the decision utility weights for some of the ICECAP dimensions but deviated for others. The largest differences were found for weights of the ICECAP-O dimension enjoyment and the ICECAP-A dimensions attachment and autonomy. Conclusions. The results suggest a different weighting of ICECAP-O and ICECAP-A levels if experienced utility is used instead of decision utility.

The Effect of Active Plus, a Computer-Tailored Physical Activity Intervention, on the Physical Activity of Older Adults with Chronic Illness(es)-A Cluster Randomized Controlled Trial

eHealth interventions aimed at improving physical activity (PA) can reach large populations with few resources and demands on the population as opposed to centre-based interventions. Active Plus is a proven effective computer-tailored PA intervention for the older adult population focusing on PA in daily life. This manuscript describes the effects of the Active Plus intervention (N = 260) on PA of older adults with chronic illnesses (OACI), compared to a waiting list control group (N = 325). It was part of a larger randomized controlled trial (RCT) on the effects of the Active Plus intervention on cognitive functioning. OACI (≥65 years) with at least one chronic illness were allocated to one of the conditions. Intervention group participants received PA advice. Baseline and follow-up measurements were assessed after 6 and 12 months. Intervention effects on objectively measured light PA (LPA) and moderate-to-vigorous PA (MVPA) min/week were analysed with multilevel linear mixed-effects models adjusted for the clustered design. Intervention effects on self-reported MVPA min/week on common types of PA were analysed with two-part generalized linear mixed-effects models adjusted for the clustered design. The dropout rate was 19.1% after 6 months and 25.1% after 12 months. Analyses showed no effects on objectively measured PA. Active Plus increased the likelihood to perform self-reported cycling and gardening at six months and participants who cycled increased their MVPA min/week of cycling. Twelve months after baseline the intervention increased the likelihood to perform self-reported walking and participants who cycled at 12 months increased their MVPA min/week of cycling. Subgroup analyses showed that more vulnerable participants (higher degree of impairment, age or body mass index) benefitted more from the intervention on especially the lower intensity PA outcomes. In conclusion, Active Plus only increased PA behaviour to a limited extent in OACI 6 and 12 months after baseline measurements. The Active Plus intervention may yet be not effective enough by itself in OACI. A blended approach, where this eHealth intervention and face-to-face contact are combined, is advised to improve the effects of Active Plus on PA in this target group.